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A look at global telemedicine trends including the drivers behind increasing adoption of electronic communications including technology and population requirements. The presentation also gives a view on market growth and segmentation in this sector.
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Cisco Confidential © 2011 Cisco and/or its affiliates. All rights reserved. 1
Global Trends in Telemedicine Dr. Mark J. Burby MB BChir
Director, Cisco Healthcare, Asia Pacific
19 October, 2011
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 2
• Telemedicine housekeeping
• Telemedicine modalities
• Applications of telemedicine
• Market overview around the world
• Challenges facing the technology
Cisco Confidential © 2011 Cisco and/or its affiliates. All rights reserved. 3
• Voice
• Fax
• Email / Messaging
• PACS
• EHR
• Video
• Medical device telemetry
• Web conferencing
• SMS
American Telemedicine Association
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 4
Claims
Agent
Specialist
Hospital A
Hospital B
Payer
Physician’s
Office
Patient’s
Home
Allow radiologists and
physicians to collaborate
in real-time through
unified communications
and image sharing
Reduce costs, and
collaborate more
effectively, and provide
better access to care
through telemedicine
Enable video communication
for caregivers to provide
language interpretation
services, education, poison
control help and psychiatric
services remotely
Provide better and more cost-
effective care through
collaboration
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 5
DATA
VOICE
VIDEO
SECURITY
Electronic Health
Records (EHR)
Remote Patient
Monitoring Disease State
Tele-health Digital Image
Transfer (PACS)
Tele-health Remote Video Consultation
50
Speed
10
(Mb)
1
Fast Faster Real-Time
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 6
Publication Date: 28 July 2011/ID Number: G00214814 Page 15 of 58
© 2011 Gartner, Inc. and/or its Affiliates. All Rights Reserved.
Figure 1. Hype Cycle for Telemedicine, 2011
Source: Gartner (July 2011)
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 7
Publication Date: 28 July 2011/ID Number: G00214814 Page 17 of 58
© 2011 Gartner, Inc. and/or its Affiliates. All Rights Reserved.
Figure 2. Priority Matrix for Telemedicine, 2011
Source: Gartner (July 2011)
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 8
• US$900m in 2007(Datamonitor)
• 2012-2013 Projections
The Wall Street Journal projects telemedicine to be a $6 billion industry by 2012.
DataMonitor projects telemedicine to be an $8 billion industry for 2012.
TechNavio Insights projects telemedicine to be a $17.8 billion industry by 2012.
Schooley Mitchell Consultants projects telemedicine to be a $4.4 billion industry by 2013 (home based).
• Over 200 telemedicine networks in US connecting over 2,000 medical institutions.
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 9
• Telesurgery/Robots In Touch Health (medical robots)
Intuitive Surgical (surgical robots) da Vinci
• Telemonitioring - Home Based Products
Honeywell
Bosch
Intel
AT&T
• Teleconsulting AMD Global Telemedicine
Polycom
Cisco/Tandberg
• Teleradiology – PACS Systems
Siemens
GE
Kodak
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 10
Telesurgery 2% Telemonitoring
13%
Teleradiology 67%
Teleconsulting 18%
Source: TechNavio Insights
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 11
• Delivery of medical care to any patient located in a remote location.
• Shortage of physicians, telemedicine provides ability to care for more patients at a distance.
• Improvement of the quality and access to care to remote and medically under-served areas.
• Financial considerations – possible savings in transportation cost savings for patient and physician.
Telemedicine has the opportunity be more
disruptive by challenging conventional
workflow and care delivery models
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 13
• Pre-configured telemedicine solutions including integrated cart solutions and integrated telemedicine case solutions.
Telemedicine Carts
Health Pod/Stations
Portable Cases
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 14
This fully integrated telemedicine cart allows care providers to:
• Capture images, video, vital signs and data
• Capture information from external imaging devices
• Forward patient cases and attached images and information to other professionals or specialists at remote locations for review and consultation
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 16
Portable Cases
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 17
Main Hospitals to Rural Hospitals including eICU’s and ER’s to monitor or triage patients
Main or Rural Hospitals to Clinic(s)
Schools- Elementary to College level, Mobile Vans
Travel – Commercial and Private Ships & Airlines
Military and Prisons based programs.
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 18
• Teleneurology
• Teleopthalmology
• Telepsychiatry
• Telepediatrics
• Teleobstetrics
• Teleultrasound
• Telemammograph
• Teleradiology
• Telerehabiliation
• Teledermatology
• Telecardiology
• Telesurgery
• Teletrauma/TeleEmergency
• Telespeech
• Telementoring
• Teleeducation
• Telehospice
• Teleforensics
Cisco Confidential © 2010 Cisco and/or its affiliates. All rights reserved. 19
Expert Gateway – translation services
Healthcare Interpreter Network
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―81% of nurses report they would save 30 to 60 minutes with instant access to experts.‖ —Forrester Research, 2006
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 21
R-Bay Architecture, courtesy C Wanscher / J Rasmussen, MedCom Denmark
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 22
The future of Telemedicine technologies are influenced by telecommunication and technology advancements
Future of telemedicine technologies…
Are influenced by:
1.Telecommunications advancements
2.Technology advancements
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 23
The da Vinci consists of 3 main parts:
A. Surgeon’s console
B. Video tower
C. 3 robotic arms
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 24
CALIFORNIA DEPARTMENT OF CORRECTIONS
• California Department of Corrections has a 170,000 population of adult prisoners in 33 institutions.
• Most prisons are located in rural areas where specialists are in short supply.
• State documents say the first telemedicine project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.
• The director of clinical operations for California Prison Health Care Services says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year.
Telemedicine Applications
Correctional Health
CALIFORNIA DEPARTMENT OF CORRECTIONS
California Department of Corrections has a 170,000 population of adult prisoners in 33 institutions.
Most prisons are located in rural areas where specialists are in short supply.
State documents say the first telemedicine project involved psychiatric counseling for inmates at Pelican Bay in Crescent City in the late 1990s.
The director of clinical operations for California Prison Health Care Services says telehealth saved taxpayers $13 million that otherwise would have been spent in guarding and transporting inmates long distances to see specialists, or about $800 per encounter just last year.
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 25
Internet-based REACH system for Telestroke at the Medical College of Georgia, USA
Internet- based REACH system for Telestroke at
the MCG, Georgia, USA
(Remote Education of Acute Ischemic Stroke)
Dr. Hess a neurologist exams a CT of the brain
via videoconferencing and teleradiology application.
REACH System Model
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 26
Greenland significantly reduced the number of unnecessary transports through telemedicine system implemented in 2008
GREENLAND’S NATIONAL MANGEMENT OF HEALTH
Problem: How can we reduce number of patients that are MedEvaced
while still providing timely and expert medical care to the entire
population of our island?
Solution: In 2008, Greenland began the process of implementing a
Telemedicine Encounter Management System
(TEMSTM). This system greatly reduced the
number of unnecessary transports and gave
the people of Greenland unprecedented
access to quality healthcare.
Telemedicine ApplicationsRural Health
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 27
US Military and VA use telemedicine to deliver care to soldiers in the field and a disparate veteran population
Telemedicine ApplicationsVeteran’s Administration
Some Veterans live many miles from a VA Medical Center, making visits to doctors or clinicians an all-day event. Others - those in chronic conditions - require constant monitoring but opt to stay at home rather than in the hospital.
In either case, telemedicine provides greater access to healthcare through the use of telecommunications and videoconferencing.
A nurse assists a Veteran with medical exam equipment while a physician tunes in
via video to offer her expertise.
Telemedicine ApplicationsMilitary
In military settings, telemedicine is being widely used to identify injury and illness and aid in the treatment, rehabilitation, and recovery of combat-wounded soldiers.
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 28
Infrastructure improvements and developments in video codec bring the possibilities of telemedicine with the convenience of mobility
Telemedicine ApplicationsMobile Health
Mobile health is aimed at expanding access to health care. A mobile clinic can travel to patients.
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 29
• Better compliancy
• Post-acute discharge monitoring
• Reduction in post-operative complications
• Improved self-care management of chronic disease
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• Reimbursement
• Cross-state/region licensure
• Care management programs
• Physician training and acceptance
• Patient privacy rules
• Bandwidth / infrastructure
• Interfacing to applications
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 31
• Small scale studies have shown clear cost savings…large scale studies are beginning to come through
• Correct implementation appears to be the most important step in achieving success (rather than technology)
• Characteristic demand for variety and customisation makes it difficult to acquire consistent cost savings data
• Cost savings data is a typical step toward development of a satisfactory reimbursement model
• Local and state government agencies often pick up the slack where federal agencies fall short
Source: Frost & Sullivan
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 32
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
2002 2003 2004 2005 2006
Lack of Security
Slow connections
Lack of interoperability
Interference between devices
Inability to achieve workflow integration
Difficult to use
Source: Medical Records Institute’s Ninth Annual Survey of Trends and Usage 2007
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 33
Health plans and Government Payers
Healthcare Providers
Employers Technology & MDCs
Change enablers
© 2011 Cisco and/or its affiliates. All rights reserved. Cisco Confidential 34
• Telemedicine is being applied today across the world in a wide variety of modalities and specialities
• More work needs to be done to demonstrate cost effectiveness and develop effective reimbursement models
• Barriers are being lowered as technology, infrastructure improves
• Some telemedicine applications will become mainstream soon, others will take time to develop – chance for differentiation
• Need for large scale studies to demonstrate benefits
• Reduction in capital and operational costs are starting and will continue to greatly improve RoI etc.
Thank you.
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